THEN there was the evidence of Surgeon-General Hamilton, formerly P.M.O., South Africa, as to the condition of the Woodstock Hospital at Capetown—"a discredit to any Government," set upon a main sewer exit and in a stench that made it frequently impossible to keep the windows open. At Bloemfontein the limitation of the medical establishment and supplies was evidently in his opinion blameworthy, since he asked that the blame shall be laid upon the proper shoulders; and he added that for years the organisation of the medical service had been calculated to result in the evils complained of.
Yet another officer in the Army Service Corps wrote from Capetown to the " Globe" complaining in similar terms of the condition of Woodstock Hospital and of its internal arrangements in the bitterest terms. No lavatories or operating room; operations performed in the wards; not even a screen to shut out the gaze of other patients; amputated limbs left exposed in the lobby; dysentery cases, typhoid cases, and surgical cases herded together in the same ward—all on the lines of the charges made by Mr. Burdett-Coutts.
The letter proceeded—" Medical comforts are deficient in quantity, but if outside help is offered it is refused, and the stereotyped official reply is given • that the Government provides all that is necessary.' My official position is sufficient authority for the truth of the stater ments that the deficiency of milk and medical comforts is quite inexcusable."
As shown by Mr. Faber in his question to the Under-Secretary for War, 127 officers and 4,260 men have died of disease in South Africa, and 844 officers and 17,666 men have been invalided home from causes other than wounds. This is a frightful record; and the question was, how far it was avoidable: Many of the men drank of poisonous streams when nearly mad with thirst, and slept in unsanitary conditions. They were exposed to the elements, their clothes were in rags, and they had short rations, before they reached Bloemfontein. Then the fever broke out to revenge the violation of the laws of health, and the only query seemed to be, did the authorities grapple with the epidemic as they should have done under the difficulties of transport?
Mr. Frederick Treves, one of the leading surgeons who visited South Africa for the purpose of treating the wounded and sick, replied to Mr. Burdett-Coutts's statements in a letter to the "British Medical Journal" as follows:
Sir,—I have read Mr. Burdett-Coutts's letter in the "Times," and am shocked and surprised at the report he furnishes.
I left Natal in March, some time after the relief of Ladysmith, and the account I gave on my return to England of the work of the Army Medical Service in Natal, was based upon my experience up to the period of my departure.
Mr. Burdett-Coutts comments upon this account as if it dealt with events which were to be in the future rather than with events which had happened in the past. To every word I have said as to the excellence of the Army medical arrangements in Natal I adhere most absolutely. It is difficult to believe that a department which stood with such success the exceptional strain of the Natal campaign can have suddenly exhibited the alarming collapse depicted by the writer of the letter in question. My experience had induced me to think that the organisation of the Army Medical Service was sound and good, that the general scheme of work and administration was efficient, and that the lavish arrangements, planned by the Director-General, were carried out by the subordinates in a liberal, thorough, and business-like manner.
There was no evidence of the intervention of red tape nor hindrance by petty formalities, and the hospital work was not only not hampered by other departments, but was helped in every way with the heartiest readiness. I cannot think that our sick have been treated with " neglect" and " inhumanity," as Mr. Burdett-Coutts asserts. Instead of neglecting their patients, the surgeons I met worked with heart and soul, sparing themselves in no particular, and of the untiring and unselfish devotion of the nurses I have already spoken.
This war has been a war of surprises. The casualties have been higher than the gloomiest ever dreamt of, and there was no reason to anticipate that the outbreak of enteric fever would assume the enormous proportions it has assumed. The circumstances of war, unfortunately, render an immense amount of suffering and distress absolutely unavoidable, and the difficulties of furnishing adequate supplies from a far distant base are extreme.
I left South Africa with the impression that nothing more could have been done, when a temperate regard for the circumstances of war was kept in mind. The Army medical service can lay no claim to the gift of prophecy, nor to the power of anticipating the future, but so far as any reasonable foresight can go the department seems to have done all that in fairness could have been expected of it. Mr. Burdett-Coutts will no doubt substantiate the points detailed in his report, but his preliminary account is conveyed in language which so savours of the theatrical that it fails to carry with it an overwhelming conviction.
Mobile field hospitals, if they have to do the work they are intended to do, cannot take beds with them. It is better for a typhoid patient to lie upon a blanket and waterproof sheet on the ground, as Mr. Coutts describes, than to be hurried helter-skelter to the base.
No human being can tell how the progress of an epidemic may proceed, nor how the numbers of the sick will be distributed. Preparations may be made for a thousand, and the admission may not reach ten. It is impossible to avoid overcrowding at times, and equally impossible to provide in every detail for emergencies which no reasonable foresight could anticipate.
That our gallant soldiers should suffer is deplorable indeed, but the blame must fall rather upon the miserable fortune of war than upon a department which has spared neither men nor money, nor care nor devotion, in a work which has assumed dimensions out of all proportion to that anticipated at the outset.
The seat of war was at least three weeks distant from the base of supplies, and in these three weeks a region free from disease may become the seat of a desperate epidemic. The movements of the troops cannot be exactly foretold. It would be better for the country to be flooded with doctors and nurses rather than the soldiers should suffer, but it is quite impossible that the medical arrangements can at a time of war overthrow all those circumstances of transport and supply upon which the conduct of the campaign depends.
Lord Roberts, in his despatches asked that the testimony of Mr. Watson Cheyne should be considered, as he travelled with the army from Paardeberg to Bloemfontein. Mr. Cheyne, writing to the British Medical Journal, said that in order to facilitate the march the military authorities reduced the number of ambulances from ten to two for each division, though the medical authorities protested that this might cause very serious delay in collecting the wounded, and that at Driefontein this warning was justified. There and at Paardeberg many of the wounded had to bivouac under trees, and, where there were no trees, under temporary blanket shelters. The wounded at Paardeberg, for lack of ambulances, were carried for three nights, two of them through rain, in jolting buck waggons with no shelter from cold or from the scorching sun. The reply to this was that military operations could not have been carried out if adequate transport and medical service had been waited for.
The English Government at once consented to a Committee of Investigation, and the subject was discussed in the House of Commons on June 29th. When Mr. Burdett-Coutts (M.P. for Westminster) went to South Africa to examine the working of the army medical system, his wife, the Baroness Burdett-Coutts, strongly approved of his mission, and it had also the sympathetic interest of Miss Florence Nightingale. Naturally it was not looked upon with much favour by the military authorities in South Africa, and from Mr. Coutts's speech in the House of Commons it was clear that he was an unwelcome visitor.
The debate was on a vote of supply. As Mr. Burdett-Coutts did not rise, Mr. Wyndham, the Under-Secretary for War, addressed the Committee. He enlarged on the ample preparations the Government made, and admitted that the troops suffered many hardships. The wounded had often to be left lying on the field of battle for many hours. The " compromises of war," Mr. Wyndham said, carried with them many terrible sufferings to those engaged. It was, as he put it, all a question of transport. He spoke of Lord Roberts's rapid march to Bloemfontein as one of the greatest achievements in war, but he reached that point with his men half starved and his horses wholly starved.
Some useful information was conveyed to the House by Mr. Wyndham:—On the ijth January, 1900, there were in South Africa 351 army medical doctors, and in June the numbers were increased to 446. In January there were 79 civilian medical officers, and in June 348, and 32 had gone out since. Of highly paid specialists there were 3 in January, and 7 in June. The total number of doctors in January employed by the War Office was 437, and in June the number had been increased to 853. Those figures did not include the civil medical practitioners in South Africa, who had so readily placed their services at the disposal of Lord Roberts. There were now (he said) 566 trained nurses with the troops, and when those who had already sailed were landed the number would be 639 nurses. In January the number of beds provided for the sick and wounded was 5,960, but in June the total was 18,840. The number of sick and wounded in January was 3,731, and on the 18th of May 11,903. Down to the most recent date there was a large excess of beds above the requirements. The scale upon which beds had been supplied was 10 per cent, for the whole force, and that was the highest that had ever been computed, and was quite high enough, even for climates like Ashanti. That scale had also been applied to all the forces which had been sent out. He was quite prepared to defend the organisation of the Army Medical Department. The Principal Medical Officer with the troops was always in the confidence of the General commanding, and he knew the distances which the troops would be required to march, and he arranged the stores accordingly. There were hardships in the firing line, and also during the time the wounded and the sick were being conveyed in the waggons to the hospitals. In a case alluded to .all the sick had to be conveyed along a single line of railway, blocked in many places 'with stores going the other way. Very often they were twenty-six hours in covering a very short distance.
As to the ambulance waggons, they were devised after long experiments by men fully acquainted with the conditions of service in the field, notably by Sir Redvers Buller. On the nth of June Lord Roberts wired that the hospital accommodation was sufficient, but since then two more general hospitals had been sent out. Mr. Wyndham received a wire on the 31st of May asking the War Office to stop sending for the present further surgical supplies.
As to Bloemfontein, in many cases the patients could not be moved after admission, and it was impossible to provide beds and mattresses for 3,000 patients all at once. Lord Roberts had said if at Bloemfontein there had been any deficiency or hardships they were accidental and temporary, and certainly were not typical of their field hospitals as a whole. On the 27th of April there were at Bloemfontein 2,000 beds, with considerable capacity for extension. Altogether there were then 2,291 patients in the military hospitals at Bloemfontein, 873 being cases of enteric fever. The field hospitals there had to be prepared for a move at any time. There was great difficulty in moving up supplies, and this also extended to stretchers, and it was quite true that some patients were placed on the ground. He had been informed that there were some twenty or thirty medical officers present at Bloemfontein, and five hospitals at the time referred to. This provided one doctor for every ten or fifteen patients.
The principal medical officer reported on the 14th of May that Lord Roberts expressed the opinion that the arrangements for the sick and wounded at Bloemfontein were most satisfactory, but that was a later date to that which the member for Westminster had called attention to. It was quite true that the sick and wounded at Bloemfontein had to undergo terrible hardships. It was also true that those who were charged with their care had exercised the greatest devotion to their duties, and the result of their labours was that the rate of mortality from enteric fever had not been abnormally high. The percentage of deaths from enteric fever in this campaign was 21, in the Nile campaign it was 28 per cent.; Dongola campaign 50 per cent., Matabele war 32 per cent., Chitral campaign 28 per cent., and in the Soudan 39 per cent. Those figures even compared favourably with the state of things in times of peace.
Mr. Burdett-Coutts, who followed Mr. Wyndam, showed no sign of flinching from his charges, and only modified them on one point. The hospital which he described at Bloemfontein he had spoken of in his letter as an illustration, but he now said that it was not a type of the rest, and was undoubtedly the worst. He had on his arrival in South Africa written to Lord Roberts asking to be allowed to go to the front. Lord Roberts took no notice of his letter, and he went to the front as an independent observer. The state of affairs to which he referred at Bloemfontein existed two months after the railway was opened. He took issue with the Under-Secretary for War on the question of military exigency. In his opinion it would have been quite possible to bring up a train with medical supplies.
Mr. Coutts stated that he had made no suggestion of brutality in the treatment of the wounded. There had, however, been a deficiency of nurses, and a deficiency of such things as disinfectants.
The first thing that struck him in Bloemfontein when he saw the crowded state of its hospitals was why more buildings were not taken for hospital accommodation. There were seven or eight buildings taken, which contained 700 patients, when there were 2,200 patients in and around Bloemfontein. There were three considerable hotels, a town hall, and stores, all of which might have been turned into hospitals, and, in addition, there was a very considerable number of comfortable private houses which were not occupied by their owners. They were taken by staff officers and military authorities. He did not say they were not justly taken, but he saw no reason why many more of them should not be taken for sick and wounded.
As a matter of fact, there was a want of medical personnel and appliances. He did not say that the personnel should have gone with Lord Roberts on his forced march, but a comparatively few days after the road to Bloemfontein was open, and it would have been perfectly possible to have sent up doctors and nurses. He considered that a great many of the evils which occurred at Bloemfontein were owing to the absence of a proper female nursing staff. A great many of the orderlies in the hospitals were untrained private soldiers who were convalescents, and he protested against the use of convalescent soldiers as orderlies in a fever hospital. Such men themselves needed rest and attention. It was a most inhuman practice, and one for which, if there had been a sufficient number of properly-trained attendants, there would have been absolutely no necessity.
They arrived at Kroonstad on the Saturday, and on the Thursday after they endeavoured to equip two buildings as hospitals. There were 300 patients, but there were only two doctors, no nurses, and no trained orderlies.
There went up with the troops dozens of correspondents, innumerable attendants, and nondescript people of different positions, and why could not doctors and orderlies have gone up also? With regard to the equipment, there had been great obstinacy and want of provision on the part of the Army Medical Department. Collapsible beds, of which hundreds could be packed in a waggon, and " tortoise" hospital tents, which would accommodate two more patients than, and only weigh half as much as, the marquees which they used, were ignored although it was known that the great difficulty was going to be that of transport.
The great vice and error in the whole of the proceedings at the front had been the absence of a proper system of stationary hospitals—hospitals which could be put into buildings on the line of march. Why, in all that idle time after the black week in December, if this equipment was at the Cape, why was it not pushed up those 500 or 600 miles to De Aar, the rail head? It would then have been easy to have got the equipment further on. But nothing was done in the way of moving the equipment up to the front. The natural result was that at Kroonstad patients were carried in by untrained hands, put on the floor without anyone to attend to them, many of them in dangerous stages of illness, and the doctors themselves complained bitterly of the want of assistance.
Owing to the lack of proper stationary hospitals convoys of sick and wounded were sent in ox waggons in which men could not lay flat, a journey of three days and nights over the veldt, in scorching heat during the day and freezing cold at night] without any extra clothing. There was no doctor or orderly, and the man sent with this particular one had no medicine, and did not know what to do although he had some men who were dying. On the 23rd of May there were eight wounded men brought to Bloemfontein Station where they lay on the platform without attention from six o'clock in the morning until half-past three in the afternoon, and four of these men were dying. Such a state of things was a scandal and a disgrace. It was no good comparing the personnel who was out there on the 15th of January, with that of the 15th of June, as by the latter date the tragedy was over.
As to Cape Town, moreover, he had not, a very favourable report to make. The equipment and staff of one of the hospitals there had been ordered up to Bloemfontein, with the result that only twenty-five nurses were left to 2,000 patients. The responsibility rested, as he thought, not upon individuals, but upon a system which was entirely inelastic.
